title: Angiotensin-converting enzyme inhibition and blood pressure response during total intravenous anaesthesia for minor surgery.
abstract: BACKGROUND
  This study investigates whether long-term treatment with an angiotensin-converting enzyme inhibitor (ACEI) impairs the haemodynamic regulation during total intravenous anaesthesia (TIVA) for minor surgery.
  
  
  METHODS
  In a prospective, two-armed observational study, 36 patients undergoing TIVA for minor surgery were studied. Seventeen were taking ACEIs regularly but no other antihypertensive medication (ACEI group); 19 patients without any cardiovascular medication served as controls (non-ACEI group). Haemodynamic variables were measured every minute during induction and every 5 min during surgery. The plasma levels of renin, angiotensin II, vasopressin and catecholamines were measured before and 18 min after the induction of anaesthesia.
  
  
  RESULTS
  The mean arterial pressure decreased to the same extent in both the groups during the induction of TIVA. There were also no differences between the groups regarding the heart rate, systolic and diastolic arterial pressure, as well as the use of vasoconstrictors, and fluids during induction and throughout surgery. In the ACEI group, the plasma renin concentration was higher at baseline and after the induction of anaesthesia presumably due to the interruption of the negative renin-angiotensin feedback loop (P<0.05). Angiotensin II increased only in the non-ACEI group (6.2 ± 2.2 before vs. 9.6 ± 3.5 pg/ml after induction; P<0.05). In both groups, the plasma norepinephrine concentration decreased after the induction of TIVA (P<0.05). Plasma vasopressin and plasma epinephrine concentrations did not change in either group.
  
  
  CONCLUSIONS
  Long-term ACEI treatment does not further aggravate the blood pressure decrease under TIVA during minor surgery, provided the induction procedure is slow, the patient is kept well hydrated and vasoconstrictors are promptly applied.
authors.affiliation: Department of Anaesthesiology and Operative Intensive Care Medicine, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany. erika.schulte@charite.de
authors.forename: E
authors.initials: E
authors.lastname: Schulte
authors.forename: D
authors.initials: D
authors.lastname: Ziegler
authors.forename: C
authors.initials: C
authors.lastname: Philippi-Höhne
authors.forename: G
authors.initials: G
authors.lastname: Kaczmarczyk
authors.forename: W
authors.initials: W
authors.lastname: Boemke
mesh_terms: D000368:Aged; D000771:Anesthesia, Intravenous; D000804:Angiotensin II / Q000097:blood; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology*; D000959:Antihypertensive Agents / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects*; D002395:Catecholamines / Q000097:blood; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D013511:Minor Surgical Procedures; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System / Q000187:drug effects; D018401:Sample Size; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014667:Vasopressins / Q000097:blood
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002395:Catecholamines; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D000804:Angiotensin II; D012083:Renin